重骨颗粒治疗肝肾亏虚型膝骨关节炎临床疗效及对骨代谢指标的影响

Clinical Efficacy of Chonggu Granule in Treatment of Knee Osteoarthritis with Deficiency of Liver and Kidney and Its Effect on Bone Metabolic Markers

目的观察重骨颗粒治疗肝肾亏虚型膝骨关节炎的临床疗效及对骨代谢指标的影响,探究其可能的作用机制。方法将60例肝肾亏虚型膝骨关节炎患者按照随机数字表法分为对照组和治疗组,每组30例。对照组患者口服盐酸氨基葡萄糖胶囊,每次1粒,每日2次,治疗组在对照组的基础上口服重骨颗粒,每次1袋,每日2次,两组各治疗8周。观察两组患者临床疗效,治疗前后视觉模拟量表(visual analogue scale,VAS)评分、西安大略和麦克马斯特大学骨关节炎指数(the Western Ontario and McMaster University osteoarthritis index,WOMAC)量表评分、Lysholm评分,血沉(erythrocyte sedimentation,ESR)、C反应蛋白(C-reactive protein,CRP)、白细胞介素-1β(interleukin-1β,IL-1β)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平,Ⅰ型前胶原羧基末端肽(caboxy-terminal typeⅠprocollagen propetide,PICP)、骨钙素(bone Gla pratein,BGP)、Ⅰ型胶原羧基端肽β降解产物(βisomer of C-terminal telopeptide of typeⅠcollagen,β-CTX)水平。结果治疗组临床疗效优于对照组(P<0.05)。治疗后治疗组VAS评分、WOMAC评分、Lysholm评分及关节隐痛、腰膝酸软评分改善情况均优于对照组(P<0.05);治疗后治疗组CRP、TNF-α、IL-1β水平降低程度均显著大于对照组(P<0.05);治疗后治疗组PICP、BGP水平升高程度、β-CTX水平降低程度均显著大于对照组(P<0.05)。结论重骨颗粒联合盐酸氨基葡萄糖治疗肝肾亏虚型膝骨关节炎的临床疗效较好且安全性高,能明显降低患者的中医证候评分,改善膝关节疼痛症状及关节功能,其作用机制可能与降低机体炎症因子水平、改善骨代谢有关。

Objective To investigate the clinical efficacy of Chonggu Granule in the treatment of knee osteoarthritis with deficiency of liver and kidney and its effect on bone metabolic markers,and to explore its possible mechanism of action.Methods A total of 60 patients with knee osteoarthritis with deficiency of liver and kidney were divided into control group and treatment group using a random number table,with 30 patients in each group.The patients in the control group were given oral administration of glucosamine hydrochloride capsules(1 capsule/time,twice a day),while those in the treatment group were given oral administration of Chonggu Granule(1 bag/time,twice a day)in addition to the treatment in the control group;the course of treatment was 8 weeks for both groups.Clinical outcome was observed for both groups,as well as visual analogue scale(VAS)score,Western Ontario and McMaster Universities osteoarthritis index(WOMAC)score,Lysholm score,and the levels of erythrocyte sedimentation(ESR),C-reactive protein(CRP),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),procollagen Ⅰ C-terminal propeptide(PICP),bone Gla protein(BGP),andβisomer of C-terminal telopeptide of type Ⅰ collagen(β-CTX)before and after treatment.Results The treatment group had a significantly better clinical outcome than the control group(P<0.05).Compared with the control group after treatment,the treatment group had significantly better improvements in VAS score,WOMAC score,Lysholm score,and the scores of dull joint pain and soreness and weakness of the waist and knees(P<0.05),significantly greater reductions in the levels of CRP,TNF-α,and IL-1β(P<0.05),significantly greater increases in the levels of PICP and BGP(P<0.05),and a significantly greater reduction in the level of β-CTX(P<0.05).Conclusion Chonggu Granule combined with glucosamine hydrochloride has good clinical efficacy and high safety in the treatment of knee osteoarthritis with deficiency of liver and kidney and can significantly reduce traditional Chinese medicine syndrome score and improve knee joint pain and joint function,possibly by reducing inflammatory factors and improving bone metabolism.